CSR CSR Pharmacology & Drug-Nutrient Interactions in Renal Disease 2 — Questions and Answers
Question 1: Cinacalcet (a calcimimetic) lowers PTH levels by activating which receptor on parathyroid gland cells?
- Vitamin D receptor
- Calcium-sensing receptor (CaSR) (Correct answer)
- Phosphate transporter
- Angiotensin receptor
Correct answer: Calcium-sensing receptor (CaSR)
Cinacalcet activates the calcium-sensing receptor on parathyroid cells, suppressing PTH secretion.
Question 2: Which adverse electrolyte effect is associated with the potassium binder patiromer due to nonselective GI binding?
- Hyperkalemia
- Hypomagnesemia (Correct answer)
- Hypernatremia
- Hyperphosphatemia
Correct answer: Hypomagnesemia
Patiromer can bind magnesium in the GI tract in addition to potassium, leading to hypomagnesemia.
Question 3: Which antibiotic class requires significant dose reduction in CKD because it is renally cleared and nephrotoxic?
- Macrolides
- Fluoroquinolones
- Aminoglycosides (Correct answer)
- Tetracyclines
Correct answer: Aminoglycosides
Aminoglycosides are renally cleared and intrinsically nephrotoxic, requiring dose adjustment to prevent accumulation in CKD.
Question 4: Sodium bicarbonate supplementation in CKD is primarily used to treat which acid-base disturbance?
- Hyperkalemia
- Metabolic acidosis (Correct answer)
- Hyponatremia
- Hyperphosphatemia
Correct answer: Metabolic acidosis
Sodium bicarbonate corrects metabolic acidosis, which is common in advanced CKD due to reduced renal acid excretion.
Question 5: Which phosphate binder contains iron as its active binding component and may contribute to iron stores?
- Calcium carbonate
- Sevelamer hydrochloride
- Sucroferric oxyhydroxide (Correct answer)
- Lanthanum carbonate
Correct answer: Sucroferric oxyhydroxide
Sucroferric oxyhydroxide is an iron-based phosphate binder that can also provide some iron supplementation benefit.
Question 6: Why must warfarin dosing be carefully managed alongside dietary vitamin K in CKD patients?
- CKD increases vitamin K absorption
- Phosphorus restriction limits vitamin K intake
- Renal disease alters warfarin metabolism and vitamin K-dependent clotting factors (Correct answer)
- Loop diuretics deplete vitamin K
Correct answer: Renal disease alters warfarin metabolism and vitamin K-dependent clotting factors
CKD alters drug clearance and clotting factor synthesis, making warfarin response unpredictable and requiring careful vitamin K monitoring.
CSR CSR Pharmacology & Drug-Nutrient Interactions in Renal Disease 2
Cinacalcet (a calcimimetic) lowers PTH levels by activating which receptor on parathyroid gland cells?